93 Decision Citation: BVA 93-01210
Y93
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 92-03 080 ) DATE
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THE ISSUES
1. Entitlement to service connection for post traumatic
stress disorder (PTSD).
2. Entitlement to service connection for bilateral
defective hearing.
REPRESENTATION
Appellant represented by: Paralyzed Veterans of America,
Inc.
ATTORNEY FOR THE BOARD
R.L. Shaw, Counsel
INTRODUCTION
The veteran had active military service from January 1968 to
August 1969, including a period of duty in Vietnam.
This matter is before the Board of Veterans' Appeals (the
Board) on appeal from a December 6, 1989, rating decision by
the Wichita, Kansas, Regional Office (RO) of the Department
of Veterans Affairs (VA). A letter notifying the veteran of
the adverse decision on his claim was mailed on December 13,
1989. A notice of disagreement was received on December l8,
1989. A second document expressing disagreement with the
rating decision was received from the veteran's
representative on March 20, 1990. The statement of the case
was issued on April 6, 1990. A statement from the veteran's
representative indicating an intent to continue the appeal
with respect to PTSD was received by the RO on September 25,
1990. A VA Form 1-9 was received from the veteran on
July 9, 1991. The case was received by the Board on
March 20, 1992, and docketed on March 23, 1992. The file
was referred to the veteran's representative, the Paralyzed
Veterans of the United States, Inc., on March 25, 1992. A
written presentation in support of the appeal dated May 1,
1992, has been received from that organization.
As developed and certified to the Board by the RO, the
appeal included the additional issues of entitlement to
service connection for headaches and an eye disability.
However, service connection was granted for headaches in
December 1989; accordingly, that issue is moot. The eye
issue was withdrawn from the appeal by the veteran's
representative in a September 1990 presentation. Neither
matter will be addressed further herein.
REMAND
The veteran contends that he has PTSD as a result of
traumatic events which occured during his period of duty in
Vietnam, where he served as a cook with the 87th Engineer
Company, 199th Infantry Brigade (Separate)(Light). In
September 1989 he filled out a questionnaire in which he
provided only vague information concerning the nature of his
service and the stressful events experienced therein (that
he helped put wounded servicemen in ambulances, that he was
subjected to frequent rocket and mortar attacks). Likewise,
VA examination reports dated in September 1989 contain
little specific information concerning the circumstances of
his service. The veteran told a social worker that a friend
had been killed "in a helicopter" but no details were
recorded. He claims also that, notwithstanding his
assigment as a cook, he performed infantry duty.
Clarification of these matters should be obtained before the
appeal is adjudicated further.
An additional clinical assessment of the current psychiatric
diagnosis should also be obtained. At a VA psychiatric
examination in September 1989, a panel of two psychiatrists
found that current symptomotology "loosely fit" the criteria
for PTSD outlined in the Diagnostic and Statistical Manual
of Mental Disorders of the American Psychiatric Association
(3rd ed., rev.) (DSM-III-R). The findings reported were
detailed and it is obvious that the examiners were
attempting to conform to the requirements of the VA
Physician's Guide for Disability Evaluation Examinations.
Nevertheless, the stated conclusion was too indefinite for
adjudication, and the examiners did not identify the
specific stressors to which the PTSD was supposedly a
reaction. Consequently, we find that, following completion
of the additional development requested herein regarding
stressors in service, an additional examination should be
conducted, again, if possible, by a panel of psychiatrists;
if PTSD is found, the manifestations should be described in
the detail, the stressor(s) should be identified, and the
evidence accepted to document the stressor(s) should be
stated.
With respect to defective hearing, the veteran claims that
he has a current hearing deficit as a result of a head
injury sustained in service when he fell off of a truck.
Service connection has been granted for headaches as a
residual of such trauma. The veteran was examined on
several occasions in June 1968 for complaints of hearing
loss and was given a physical profile but the audiograms
were inconsistent and deemed unreliable. Otitis was
reported. (It should be noted that hearing impairment in
the right ear was shown on examination for induction.). The
veteran was reported on a VA examination in September 1989
to be totally deaf in the right ear as a result of a post
service explosion in 1979, but treatment records from the
University of Kansas contain no reference to this deafness.
These circumstances raise a question as to the etiology of
current hearing loss. The veteran has never received a VA
audiological examination.
The Board finds that the veteran's claim is well grounded
within the meaning of 38 U.S.C.A. § 5107(a) (West 1991) and
that additional development of the evidence is required to
satisfy the statutory obligation of this Department to
assist in the development of the evidence to support a
well-grounded claim. Accordingly, the appeal is REMANDED
for the following actions:
1. The RO should obtain any additional
VA outpatient treatment records pertain-
ing to psychiatric symptomotology.
2. The veteran should be asked to
provide details regarding the
circumstances of his military service,
including the nature and extent of all
combat, and the specifics of events
claimed as stressors for PTSD. The
friend "killed in a helicopter" should be
identified by and, if possible, his unit
affiliation should be indicated, as
should the date and location of his
death.
3. Upon receipt of this information, the
RO should contact the United States Army
and Joint Services Environmental Support
Group (ESG), Building 5089, Stop #387,
Fort Belvoir, Virginia 22060, and request
corroborating documentation. Any
available narrative unit histories
detailing actual operations performed by
his unit should be requested. Similar
information concerning the death of the
specific individual named by the veteran
should be requested.
4. Upon completion of the foregoing, and
only then, the veteran should be referred
for an examination (if possible by a
panel of psychiatrists) to ascertain the
nature of all current psychiatric
pathology. The examination should be
conducted in accordance with the
requirements of the VA Physician's
Guide. (Specifically, paragraphs 20.1 to
20.5 thereof should be considered in
addition to the general provisions of
Chapter 14.) If the veteran is found to
have PTSD satisfying the diagnostic
criteria of Code 309.89 of (DSM-III-R),
the symptoms and other factors which
support the diagnosis should be
specifically itemized. If coexisting
psychopathology is also identified, such
pathology should be described in detail.
In addition, if PTSD is found, the
examiners should be requested to iden-
tify the specific stressors that caused
the PTSD and specify the evidence relied
upon to determine the existence of the
stressors. It is imperative that the
claims file in this case be made available
to the examiners for advance review prior
to the examination.
5. The veteran should undergo a special
ear, nose, and throat examination,
including audiometric testing. The
examination should be conducted in
accordance with the requirements of the
VA Physician's Guide. The examiner(s)
should review the file and express a
opinions as to the etiology of any
current hearing deficit and whether such
loss is related to the hearing deficit
described in service medical records. It
is imperative that the claims file be
made available to the examiners(s) in
advance.
When the foregoing development has been completed, the claim
should be reviewed by the originating agency. If the deci-
sion remains adverse to the veteran, a supplemental statement
of the case should be prepared and the veteran and his
attorney should be given a reasonable period of time for
reply. Thereafter, the claim should be returned to the Board
for further review.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
STEPHEN L. WILKINS (Member temporarily absent)
DANIEL J. STEIN
*38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of
the Board, to proceed with the transaction of business
without awaiting assignment of an additional Member to the
Section when the Section is composed of fewer than three
Members due to absence of a Member, vacancy on the Board or
inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section
proceed with the transaction of business, including the
issuance of decisions, without awaiting the assignment of a
third Member.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United
States Court of Veterans Appeals. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal. 57 Fed.
Reg. 4126 (1992) (to be codified as 38 C.F.R. § 20.1100(b)).